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Background In the UK certain groups with pre-disposing conditions are eligible for vaccination with the pneumococcal polysaccharide vaccine (PPV23). Uptake of the vaccine in these individuals has not been reported for 10 years. Hence this study investigated the rates of pneumococcal vaccination, the time to vaccination since diagnosis, and factors associated with vaccination in individuals aged 18–64 years with certain underlying medical conditions. Methods A retrospective database analysis was conducted using the Clinical Practice Research Datalink (CPRD). Individuals aged 18 to 64 years who had a diagnosis for underlying medical conditions of interest at the index date (January 1, 2011 to December 31, 2015) were included in this study. Both underlying conditions and pneumococcal vaccination were identified using Read codes. A multivariable logistic regression model was used to identify factors associated with pneumococcal vaccination. Results A total of 99,153 individuals with underlying medical conditions were included in this study. Within 1 year of follow-up, 13.6% had received pneumococcal vaccination. This figure rose to 32.0% after 4 years of follow-up. The mean time between diagnosis and vaccination was 148.7 days across the overall cohort. Based on multivariate analysis of results, individuals with chronic heart disease, chronic kidney disease, chronic liver disease, chronic respiratory disease or diabetes mellitus were significantly less likely ( P  < 0.0001) to be vaccinated than those with immunosuppression. Individuals were significantly more likely to receive a pneumococcal vaccination if they received an influenza vaccination in the first year of follow-up than those who did not ( P  < 0.001). Conclusions Despite the Joint Committee on Vaccination and Immunisation (JCVI) recommendations for pneumococcal vaccination in clinical risk groups, rates of pneumococcal vaccination are suboptimal in the UK for individuals aged 18–64 with underlying medical conditions. Further emphasis should be made on the importance of increased pneumococcal vaccination coverage in the UK, given the increased risk of morbidity and mortality associated with indicative underlying medical conditions.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends pneumococcal vaccination for adults with chronic or immunocompromising conditions to prevent pneumococcal disease, yet vaccination rates are low and have limited information on regional variation. This study examines factors associated with pneumococcal vaccination in adults with underlying conditions and describes regional variation in vaccination across the U.S. Using IBM MarketScan Commercial Database and Medicare Supplemental Database, this retrospective cohort study included adults ages 19–64 newly diagnosed with chronic (i.e. diabetes, chronic heart, lung, or liver disease, alcohol or tobacco dependence) or immunocompromising (i.e. cancer, chronic renal disease, organ transplant, HIV/AIDS, and asplenia) conditions in 2013. Adults were followed up until the time of pneumococcal vaccination, death, or December 31, 2019, whichever came first. Cox proportional hazards model was used to examine factors associated with vaccination. Vaccination rate was calculated by metropolitan statistical area (MSA) and visually represented on a U.S. map. 255,330 adults were included. Vaccination rate increased from 6.0% to 21.1% among adults with one year and five years of follow-up, respectively. It took 2.4 years on average for adults to receive vaccination after initial diagnosis. Adults ages 50–64, 35–49 (relative to 19–34) or receiving influenza vaccination were more likely to receive pneumococcal vaccinations. Adults with HIV/AIDS were more likely and those with other conditions were less likely to be vaccinated than those with diabetes. Adults being diagnosed by other providers were less likely to be vaccinated than those diagnosed by primary care providers. Vaccination rate varied largely across MSAs, ranging from 0.0% (Ames, IA; Cheyenne, WY) to 34.0% (Ann Arbor, MI). Pneumococcal vaccination remains low and most adults with underlying conditions are unvaccinated. Insights into factors associated with vaccination, including regional variability, can help to increase pneumococcal vaccination.

Introduction: The objective of our study was to assess, in an at-risk population, perception and knowledge about influenza and pneumococcal vaccinations. Methods: An anonymous web-based survey was submitted to patients recruited in France, from both an Ipsos internal panel and AVNIR patient associations. The study was conducted between July and October 2020, in the context of the COVID-19 pandemic. Results: Overall, 2177 questionnaires from patients at risk of infection were analyzed. Almost all respondents (86%, 1869/2177) declared themselves to be favorable to vaccination. Nearly half of the patients (49%, 1069/2177) were aware of which vaccine was recommended for their specific situation. This percentage was significantly (p < 0.001) higher for members of a patient association and for people affected by multiple chronic conditions and varied according to the type of condition. Almost two-thirds of patients (1373/2177) declared having been vaccinated during the 2019/2020 influenza season, and 41% (894/2177) were certain about being up to date with the pneumococcal vaccination. The main barriers to vaccination for influenza are the fear of side effects, doubt regarding the efficacy of the vaccine and for pneumococcal vaccination, and the absence of suggestions by the healthcare professionals (HCPs), as 64% of respondents were not recommended to obtain pneumococcal vaccination. To improve vaccine coverage, information is of prime importance and GPs are recognized as the main HCP to inform about vaccination. Nearly two-thirds (62%, 1360/2177) of patients declared that the COVID-19 pandemic convinced them to have all the recommended vaccines. Conclusion: Our study highlighted the nonoptimal vaccine coverage in at-risk populations despite a highly positive perception of vaccines and confirmed that physicians are on the front lines to suggest and recommend these vaccinations, especially in the current pandemic context, which may be used to promote other vaccines.

Pneumococcal disease contributes to significant morbidity in the United States. Before October 2024, the Advisory Committee on Immunization Practices recommended pneumococcal vaccination for risk-eligible adults aged 19–64 years; however, as of 2023, vaccination coverage remained low (33.1 %). To understand factors associated with low vaccination coverage, in January 2024, a web-based survey was conducted among risk-eligible adults aged 19–64 years examining their knowledge, attitudes, and practices toward pneumococcal vaccination. Of 1533 eligible participants, 39.2 % self-reported having received pneumococcal vaccination. Compared with vaccinated participants, unvaccinated participants were less familiar with and had lower perceived risk of pneumococcal disease and were less willing to receive pneumococcal vaccination following healthcare provider recommendation. Common reasons for not being vaccinated were lack of understanding of vaccine-qualifying risk conditions and lack of healthcare provider recommendations. A multi-faceted approach, including optimization of provider and patient education, is necessary to increase vaccination coverage among risk-eligible adults.

Antimicrobial resistance (AMR) poses a serious threat to global public health. However, vaccinations have been largely undervalued as a method to hinder AMR progression. This study examined the AMR impact of increasing pneumococcal conjugate vaccine (PCV) coverage in China. China has one of the world’s highest rates of antibiotic use and low PCV coverage. We developed an agent-based DREAMR (Dynamic Representation of the Economics of AMR) model to examine the health and economic benefits of slowing AMR against commonly used antibiotics. We simulated PCV coverage, pneumococcal infections, antibiotic use, and AMR accumulation. Four antibiotics to treat pneumococcal diseases (penicillin, amoxicillin, third-generation cephalosporins, and meropenem) were modeled with antibiotic utilization, pharmacokinetics, and pharmacodynamics factored into predicting AMR accumulation. Three PCV coverage scenarios were simulated over 5 y: 1) status quo with no change in coverage, 2) scaled coverage increase to 99% in 5 y, and 3) accelerated coverage increase to 85% over 2 y followed by 3 y to reach 99% coverage. Compared to the status quo, we found that AMR against penicillin, amoxicillin, and third-generation cephalosporins was significantly reduced by 6.6%, 10.9%, and 9.8% in the scaled scenario and by 10.5%, 17.0%, and 15.4% in the accelerated scenario. Cumulative costs due to AMR, including direct and indirect costs to patients and caretakers, were reduced by $371 million in the scaled and $586 million in the accelerated scenarios compared to the status quo. AMR-reducing benefits of vaccines are essential to quantify in order to drive appropriate investment.

Invasive pneumococcal disease (IPD) is associated with a significant clinical and economic burden among adults ≥65 years of age in Europe. The distribution of bacterial serotypes responsible for IPD has changed over time, including in response to the introduction of pediatric and adult pneumococcal conjugate vaccines (PCVs). These shifts necessitate the ongoing development of new multivalent vaccines to ensure that pneumococcal vaccination programs continue to target serotypes associated with significant disease burden. The aim of the current study was to compare the proportion of IPD cases among adults ≥65 years of age that are targetable with PCV21 compared to PCV20 in multiple European countries, and to assess trends in these proportions over time. We synthesized age- and serotype-specific IPD incidence data from 2011 to 2023. Data were obtained from government surveillance reports and peer-reviewed publications. Continuous serotype-specific data on the incidence of IPD among adults ≥65 years of age were available for 15 European countries. The average proportion of these IPD cases that were targetable by PCV21 increased during the study period; from 2014 onward, this proportion exceeded the proportion of cases targetable by PCV20, with an overall difference in serotype coverage of 14.0 % by 2023. These trends were driven largely by 8 countries that had a markedly higher reported incidence of IPD between 2011 and 2019 compared to the other 7 countries. In many European countries, PCV21-targetable serotypes are now responsible for more cases of IPD among adults ≥65 years of age than are PCV20-targetable serotypes. Implementing PCV21 in adult pneumococcal vaccination programs may therefore help reduce the clinical and economic burden of IPD among this high-risk age group. •This study synthesizes invasive pneumococcal disease data in Europe (2011−2023).•PCV21 targeted more cases in adults ≥65 than PCV20 in many European countries.•Serotype coverage of PCV21 exceeded PCV20 in 15 European countries from 2014 onward.•By 2023, PCV21 covered 14 % more cases than PCV20 among older European adults.•PCV21 vaccination may reduce the burden of invasive pneumococcal disease in Europe.

Pneumococcal vaccination is a crucial preventive measure for older adults, yet delays and disparities in vaccine uptake persist. This study aimed to evaluate temporal trends and disparities in pneumococcal vaccination rates among older adults based on demographic, socioeconomic, geographic, and clinical factors. We conducted a population-based retrospective cohort study on adults aged 65 years, eligible for the pneumococcal vaccine between 2015 and 2023. The association between demographic, geographic, and health-related factors and vaccination delays, as well as temporal trends in vaccination rates, were examined. The primary outcome was the time to pneumococcal vaccination within one year of eligibility. Among 137,997 eligible individuals, only 34 % (47,580) were vaccinated within one year of eligibility. Vaccination rates declined over the study period, from 39 % in 2015 to 23 % in 2023 (annual rates: 39 %, 38 %, 35 %, 36 %, 40 %, 32 %, 27 %, 23 %). Time to vaccination increased after 2020, particularly following the onset of the coronavirus disease 2019 (COVID-19) pandemic. Shorter vaccination times were observed in males, Arabs, and residents of peripheral regions. Prior influenza vaccination strongly predicted timely pneumococcal vaccination (hazard ratio [HR] =2.1, 95 % confidence interval [CI] 1.9–2.3). Comorbidities such as hypertension and recent hospitalizations were also associated with shorter times to vaccination. In contrast, smokers and underweight individuals experienced longer times to vaccination (HR = 0.93, 95 %CI 0.90–0.95; HR = 0.81, 95 %CI 0.73–0.90, respectively). Delays in pneumococcal vaccination uptake among older adults are influenced by demographic, geographic, and health-related factors. The significant decline in vaccination rates over the years, exacerbated by the COVID-19 pandemic, underscores the need for public health strategies. Targeted interventions to improve vaccine accessibility, raise awareness, and address healthcare inequities are essential to mitigate these disparities, achieve and exceed pre-pandemic vaccination levels, and ensure the healthcare system is prepared for future crises. •Pneumococcal vaccination rates declined from 2015 to 2023 in older adults.•COVID-19 exacerbated delays in pneumococcal vaccination uptake post-2020.•Male gender, Arab ethnicity, and peripheral residency linked to faster vaccination.•Prior influenza vaccination strongly predicted timely pneumococcal vaccine uptake.

Age (> 50 years) is a risk factor for pneumococcal disease, but is not an indication for vaccination in France, by contrast to influenza. In 2018, the pneumococcal vaccine coverage rate (VCR) was 4.5% in adults at-risk, in contrast to the influenza VCR, which was 43.6%. We aimed to assess pneumococcal and influenza VCR in 2020 in the entire French population and factors associated with a higher VCR (including the age of 65 years). We retrospectively included all adults covered by the National Health Service in 2020 and identified patients at-risk using validated algorithms. We assessed VCRs by analysing pneumococcal vaccines reimbursed between 2009 and 2020 (13-valent pneumococcal conjugate vaccine [PCV13] and 23-valent polysaccharide vaccine [PPSV23]), and influenza vaccines reimbursed between September 2020 and March 2021. In 2020, we identified 7,336,769 adults at risk (median age: 67.0 years): 84.2% had comorbidities and 24.5% were immunocompromised. The overall pneumococcal VCR (PCV13 + PPSV23) was 9.9% and the seasonal influenza VCR was 51.1%. The variable associated with the highest odds of VCR was an \"age ≥65 years\" for influenza (odds ratio [OR] 4.14), but not for pneumococcal vaccination (OR 1.02). In patients with comorbidities, pneumococcal VCR did not significantly increase between those aged 18-65 years and those aged > 65 years (7.2% to 9.4%), and even decreased from 20% to 17.9% in patients with immunodeficiencies. In contrast, influenza VCR increased significantly from 35.5% to 67.9% (OR 3.55) in patients with comorbidities, and from 27.3% to 71.2% (OR 5.57) in those with immunodeficiencies. In France, pneumococcal VCR did not increase above 65 years of age (OR 1.02), by contrast to influenza VCR (OR 4.14) that increased significantly, suggesting that an age-based recommendation for pneumococcal vaccination will probably benefit to VCR in at-risk, elderly population.

A general recommendation for adult pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) for adults 60 and older has been in place in Germany since 1998, but uptake has been low. Just over a decade after the implementation of an infant pneumococcal conjugate vaccine recommendation, we examined indirect protection effects on adult invasive pneumococcal disease (IPD) in Germany. Reported IPD cases decreased in children under two years of age from 11.09 per 100,000 in 2003-2006 to 5.94 per 100,000 in 2017/18, while in adult age groups, reported IPD cases rose across the board, most dramatically in adults 60 years of age and over, from 1.64 to 10.08 cases per 100,000. PCV13-type IPD represents 31% of all cases in this age group, the lion's share of which is due to the rapid increase of serotype 3 IPD, which, by itself, has reached 2.11 reported cases per 100,000 and makes up 21% of all IPD cases in this age group. The two vaccine formulations currently in development (PCV15 and PCV20) would increase current (PCV13) coverage by 8.5% points and 28.0% points in children, while in adults coverage would increase by 10.4% points and 21.9% points, respectively. While original models predicted that indirect effects of childhood vaccination would suffice for adults, it seems that the herd protection effect has reached its limit, with vaccine serotypes 4, 19F, and 19A IPD persisting in adults after initial reductions, and serotype 3 IPD not showing any herd protection effect at all.

Pneumococcal vaccination is recommended for older adults and individuals with chronic medical conditions (CMC) due to the high risk of invasive pneumococcal disease in these groups. Despite this, vaccination coverage in Canada remains below the national target of 80%, to be achieved by 2025. We conducted a new analysis of recently released data from the Canadian Longitudinal Study on Aging (CLSA), aimed at providing estimates of pneumococcal vaccine coverage from 2018-2021 among eligible adults, identifying sociodemographic disparities, and exploring changes over time since 2015. The CLSA, a nationally representative cohort launched in 2011, recently released data collected during the second follow-up visit (FUP2; 2018-2021). We conducted a cross-sectional analysis of participant self-reported pneumococcal vaccination status, stratified by sociodemographic characteristics, receipt of influenza vaccine in the previous 12 months, and contact with family doctor in the previous 12 months. Logistic regression was used to identify factors associated with being newly vaccinated for pneumococcal disease as reported during FUP2 compared with three years earlier during follow-up 1 (FUP1; 2015-2018). We previously reported pneumococcal vaccination estimates for 2015-2018. Only 56.8% (95% CI: 55.8-57.7%; n = 10,530) of eligible study participants aged 65 years and older and 19.3% (95% CI: 18.1-20.5%; n = 4,055) of those aged <65 years with at least 1 chronic medical condition reported having received the pneumococcal vaccine when surveyed between 2018-2021. Males, rural residents, and individuals in certain provinces reported lower vaccination rates. Compared to three years prior, 28.4% of participants aged 65 years and older and 11% of participants aged <65 years with at least one CMC reported being newly vaccinated. Higher odds of being newly vaccinated were observed among individuals who reported having received influenza vaccination in the previous 12 months in both age groups. Pneumococcal vaccine coverage among Canadian adults aged 65 and older enrolled in the CLSA increased by only 2% between 2015-2018 and 2018-2021, and no changes were observed among those under the age of 65 with underlying conditions.